Online Franchisee Application Form

Basic Institute Details
Name of Institute / Organization *
Complete Office Address * H.No., Vill+Post, Thana, Pin Code	*
State & District	Select State Select State Uttar Pradesh Bihar Jharkhand Andaman & Nicobar Andhra Pradesh Arunachal Pradesh Assam Chandigarh Chhattisgarh Dadar & Nagar Haveli Daman & Diu Delhi Goa Gujarat Haryana Himanchal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharastra Manipur Meghalaya Mizoram Nagaland Orissa Puducherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttrakhand West Bengal Shahjahanpur Uttranchal Uttranchal Select District Select District
Office Mobile No. *
Alternate Mobile No.
Director Details
Owner's Name *	Enter Name
Father's Name *	Enter Father Name
Gender *	Select Select Male Female Select Gender
Religion *	Select Select Hindu Muslim Sikh Christian Parsi Other Select Religion
Category *	Select Select General OBC (Other Backward Caste) SC (Scheduled Caste) ST (Scheduled Tribe) Other Select Category
Aadhar No. (If Alloted)
Complete Home Address * H.No., Vill+Post, Thana, Pin Code	*
E-mail *	Enter Email
Last Qualification *
Technical Qualification *
Infrastructure Details
Institute Area in Sq. Feet *
No. of Computers *
No. of Class Room *
No. of Lab Room *
Director Cabin *	Select Select Yes No
Counselor Cabin *	Select Select Yes No
Water Tape *	Select Select Yes No
Toilet/Urinary*	Select Select Yes No
No. of Employees *
Upload Photo *